I would really appreciate if you advise on which protocol would be preferable for PCOS patients – step-up or step-down. I did IVF recently with 22 eggs retrieved but unfortunately all of them were very bad quality. This time we used step-down protocol starting from 115ui Gonal F and then after 5 days decreasing it to 75ui. But after decreasing the dose my follicles almost stopped growing and it was upped again to 115. We had 22 eggs retrieved but all of them were very bad quality. At the follow up consultation doctor she advised us to use step-down protocol next time meaning starting from very low dose of Gonal F and gradually increasing it.

But now we decided to change clinic and our new consultant saying that for PCOS women step-down protocol is more effective. I’m very confused and not sure what to do now.

I would be very grateful if you could give your opinion what stimulation protocol works better for PCOS.

Thanks a lot Dr Jacobs for you reply, I really appreciate it. I think we would go with step down protocol this time as my current doctor thinks it is the best too.

Also I was wondering if you think that evaluated progesterone levels could be the reason for poor egg quality. The thing is that during my last stimulation I was on 115ui Gonal F for 5 days and my follicles were growing pretty steadily for this period but I had too many of them and my dose was reduced to 75ui. They continue to grow for 2 more days but then stopped and for the next few days I experienced exactly the same symptoms as I usually get after ovulation (very sore nipples, change in discharge and so on). I’m pretty sure that I had progesterone surge at that time. Then my dose was upped again to 115 but unfortunately all eggs were very bad quality and I was wondering if progesterone was the reason for that.